Clinical Article J Korean Neurosurg Soc 60 (5) : 511-517, 2017 https://doi.org/10.3340/jkns.2016.1011.003
pISSN 2005-3711 eISSN 1598-7876
Cerebral Arterial Stenosis in Patients with Spontaneous Intracerebral Hemorrhage Pil-Wook Chung, M.D., Ph.D.,1 Yu Sam Won, M.D., Ph.D.2 Departments of Neurology,1 Neurosurgery,2 Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Objective : Spontaneous intracerebral hemorrhage (ICH) and ischemic stroke share common vascular risk factors such as aging and hypertension. Previous studies suggested that the rate of recurrent ICH and ischemic stroke might be similar after ICH. Presence of cerebral arterial stenosis is a potential risk factor for future ischemic stroke. This study investigated the prevalence and factors associated with cerebral arterial stenosis in Korean patients with spontaneous ICH. Methods : A total of 167 patients with spontaneous ICH were enrolled. Intracranial arterial stenosis (ICAS) and extracranial arterial stenosis (ECAS) were assessed by computed tomography angiography. Presence of ICAS was defined if patients had arterial stenosis in at least one intracranial artery. ECAS was assessed in the extracranial carotid artery. More than 50% luminal stenosis was defined as presence of stenosis. Prevalence and factors associated with presence of ICAS and cerebral arterial stenosis (presence of ICAS and/or ECAS) were investigated by multivariable logistic regression analysis. Results : Thirty-two (19.2%) patients had ICAS, 7.2% had ECAS, and 39 (23.4%) patients had any cerebral arterial stenosis. Frequency of ICAS and ECAS did not differ among ganglionic ICH, lobar ICH, and brainstem ICH. Age was higher in patients with ICAS (67.6±11.8 vs. 58.9±13.6 years p=0.004) and cerebral arterial stenosis (67.9±11.6 vs. 59.3±13.5 years, p18 years. The exclusion criteria were ICH due to secondary causes like arteriovenous malformation, Moyamoya disease, traumatic ICH, aneurysm, neoplasm, and hemorrhagic conversion of cerebral infarction. The local institutional review board ap512
https://doi.org/10.3340/jkns.2016.1011.003
proved this retrospective study and waived the need for informed consent.
CTA and cerebral arterial stenosis CTA was used to analyze the presence of intracranial and extracranial stenosis. All patients underwent multi-detector CTA, which was performed using a Brilliance 40-channel CT v2.2 (Philips Medical System, Best, The Netherlands) with the following parameters : 120 kVp, 300 mA, 0.8 mm slice thickness, 0.3 mm slice acquisition interval, a pitch of 0.67, and intravenous administration of 150 mL of iodinated contrast media (Omnipasque 300) at a rate of 4.0–4.5 mL/s under the control of an auto-injection protocol. Imaging data were transferred to two computer workstations (Extended Brilliance Workspace v3.0 and Rapidia v2.8) for post-processing. Stenosis was determined as the ratio of the diameter at the segment of most severe stenosis divided by the diameter of a proximal or nearby normal segment21). More than 50% stenosis was defined as arterial stenosis. We analyzed stenosis for intracranial artery and extracranial artery. Intracranial arteries that were evaluated were the intracranial segment of internal carotid artery, basilar artery, anterior cerebral artery, middle cerebral artery, and posterior cerebral artery. Extracranial stenosis was analyzed in the extracranial portion of the internal carotid artery. We excluded the extracranial and intracranial vertebral arteries from this analysis since the hypoplastic vertebral arteries are frequently found in normal subjects, which make it difficult to differentiate between non-specific hypoplasia and atherosclerotic stenosis. Location of ICH were categorized as lobar (cortical and subcortical), ganglionic (putamen and thalamus), and infratentorial (brainstem and cerebellum).
Clinical characteristics The Glasgow coma scale was recorded to assess the initial neurological status on admission, and patient’s functional outcome at discharge and 90 days were assessed using the Glasgow outcome scale (1 to 5, good recovery to death). Hypertension was defined as a self-reported use of blood pressure-lowering medication or history of hypertension or blood pressure >160/100 mmHg at least 1 week after stroke onset. Diabetes mellitus was defined present if patient was taking hypoglycemic medication or had a random glucose
Intracerebral Hemorrhage and Cerebral Arterial Stenosis | Chung PW, et al.
level ≥200 mg/dL. Dyslipidemia was defined when using anti-lipidemic agent or total cholesterol level ≥220 mg/dL or low-density lipoprotein cholesterol level ≥160 mg/dL. Current cigarette smoking was considered a positive smoking habitus. The estimated glomerular filtration rate (eGFR) was calculated using the equation proposed by the MDRD study group13).
Statistical analysis Baseline characteristics and location of ICH were compared between patients with ICAS and without ICAS. We also compared patients with cerebral arterial stenosis (defined as presence of ICAS and/or ECAS) and those without cerebral arterial stenosis. Baseline characteristics and location of ICH were compared using chi-square test and the Student t-test, as appropriate. Multivariable analyses were performed via multiple logistic regression to determine the factors associated with presence of ICAS and cerebral arterial stenosis. In multivariable analysis, variables with p
pISSN 2005-3711 eISSN 1598-7876
Cerebral Arterial Stenosis in Patients with Spontaneous Intracerebral Hemorrhage Pil-Wook Chung, M.D., Ph.D.,1 Yu Sam Won, M.D., Ph.D.2 Departments of Neurology,1 Neurosurgery,2 Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Objective : Spontaneous intracerebral hemorrhage (ICH) and ischemic stroke share common vascular risk factors such as aging and hypertension. Previous studies suggested that the rate of recurrent ICH and ischemic stroke might be similar after ICH. Presence of cerebral arterial stenosis is a potential risk factor for future ischemic stroke. This study investigated the prevalence and factors associated with cerebral arterial stenosis in Korean patients with spontaneous ICH. Methods : A total of 167 patients with spontaneous ICH were enrolled. Intracranial arterial stenosis (ICAS) and extracranial arterial stenosis (ECAS) were assessed by computed tomography angiography. Presence of ICAS was defined if patients had arterial stenosis in at least one intracranial artery. ECAS was assessed in the extracranial carotid artery. More than 50% luminal stenosis was defined as presence of stenosis. Prevalence and factors associated with presence of ICAS and cerebral arterial stenosis (presence of ICAS and/or ECAS) were investigated by multivariable logistic regression analysis. Results : Thirty-two (19.2%) patients had ICAS, 7.2% had ECAS, and 39 (23.4%) patients had any cerebral arterial stenosis. Frequency of ICAS and ECAS did not differ among ganglionic ICH, lobar ICH, and brainstem ICH. Age was higher in patients with ICAS (67.6±11.8 vs. 58.9±13.6 years p=0.004) and cerebral arterial stenosis (67.9±11.6 vs. 59.3±13.5 years, p18 years. The exclusion criteria were ICH due to secondary causes like arteriovenous malformation, Moyamoya disease, traumatic ICH, aneurysm, neoplasm, and hemorrhagic conversion of cerebral infarction. The local institutional review board ap512
https://doi.org/10.3340/jkns.2016.1011.003
proved this retrospective study and waived the need for informed consent.
CTA and cerebral arterial stenosis CTA was used to analyze the presence of intracranial and extracranial stenosis. All patients underwent multi-detector CTA, which was performed using a Brilliance 40-channel CT v2.2 (Philips Medical System, Best, The Netherlands) with the following parameters : 120 kVp, 300 mA, 0.8 mm slice thickness, 0.3 mm slice acquisition interval, a pitch of 0.67, and intravenous administration of 150 mL of iodinated contrast media (Omnipasque 300) at a rate of 4.0–4.5 mL/s under the control of an auto-injection protocol. Imaging data were transferred to two computer workstations (Extended Brilliance Workspace v3.0 and Rapidia v2.8) for post-processing. Stenosis was determined as the ratio of the diameter at the segment of most severe stenosis divided by the diameter of a proximal or nearby normal segment21). More than 50% stenosis was defined as arterial stenosis. We analyzed stenosis for intracranial artery and extracranial artery. Intracranial arteries that were evaluated were the intracranial segment of internal carotid artery, basilar artery, anterior cerebral artery, middle cerebral artery, and posterior cerebral artery. Extracranial stenosis was analyzed in the extracranial portion of the internal carotid artery. We excluded the extracranial and intracranial vertebral arteries from this analysis since the hypoplastic vertebral arteries are frequently found in normal subjects, which make it difficult to differentiate between non-specific hypoplasia and atherosclerotic stenosis. Location of ICH were categorized as lobar (cortical and subcortical), ganglionic (putamen and thalamus), and infratentorial (brainstem and cerebellum).
Clinical characteristics The Glasgow coma scale was recorded to assess the initial neurological status on admission, and patient’s functional outcome at discharge and 90 days were assessed using the Glasgow outcome scale (1 to 5, good recovery to death). Hypertension was defined as a self-reported use of blood pressure-lowering medication or history of hypertension or blood pressure >160/100 mmHg at least 1 week after stroke onset. Diabetes mellitus was defined present if patient was taking hypoglycemic medication or had a random glucose
Intracerebral Hemorrhage and Cerebral Arterial Stenosis | Chung PW, et al.
level ≥200 mg/dL. Dyslipidemia was defined when using anti-lipidemic agent or total cholesterol level ≥220 mg/dL or low-density lipoprotein cholesterol level ≥160 mg/dL. Current cigarette smoking was considered a positive smoking habitus. The estimated glomerular filtration rate (eGFR) was calculated using the equation proposed by the MDRD study group13).
Statistical analysis Baseline characteristics and location of ICH were compared between patients with ICAS and without ICAS. We also compared patients with cerebral arterial stenosis (defined as presence of ICAS and/or ECAS) and those without cerebral arterial stenosis. Baseline characteristics and location of ICH were compared using chi-square test and the Student t-test, as appropriate. Multivariable analyses were performed via multiple logistic regression to determine the factors associated with presence of ICAS and cerebral arterial stenosis. In multivariable analysis, variables with p
